Development of the Depression in Chronic Illnesses Scale

Development of the Depression in Chronic Illnesses Scale Patient Health Questionnaire depression scale (PHQ) is an eighty-two items measure, divided into five clinical components (Kroenke, Spitzer Williams, 2001). PHQ is used to assess mood, anxiety, somatoform inclination, alcoholism and disorders related to eating habits. PHQ is found to be beneficial in primary care settings because of the early screening and detection the disorder. Responses ranging from â€Å"not at all to nearly every day† and score from 0 to 3 points. Respondents asked to mark his/her feelings they gone through by the past two weeks. PHQ has three shorter versions; one with nine items derived from the original version called Patient Health Questionnaire Depression Scale-9 (PHQ-9), eight items and two item versions are called PHQ-8 (Kroenke, Strine, Spitzer, Williams, Berry Mokdad, 2008)and PHQ-2 respectively. Zung Depression Inventory (Zung, 1965) is a 20 items self-rating depression inventory for diagnosis depression in psychiatric settings. Where, 20 items divided into 10 negative statements and 10 positive statements, included affective, somatic and psychological symptoms of depression. The response format ranged from 1 (a little of the time) to 4 (most of the time) points scale and the diagnostic scores divide into category of four. Scores ranging between 20-80 points, where, less than50 regarded normal, less than 60 as having mild depression, less than 70 as having major depression, while 70 and above regarded as severe major depression. Besides the adolescents and adult depression measures, there was a need to have measures for assessing depression in geriatric people. There is not much work done on this issue. Depression is not a process of aging, though somewhat people affected by it in their late life. The reason could be retirement from jobs, impairment in daily routine, cognitive functioning, and decreased quality of life (Blazer, 2009). Among other measure of depression available, Geriatric Depression Scale (GDS) is uses commonly in hospitals and by other health care professionals (Yesavage, Brink, Rose, Lum, Huang, Adey Leirer, 1983). GDS is developed by Yesavage (1982) in a dichotomous yes/no format, has two measures one is long form consisting 30-item questionnaire, while other is short form consisting 15-item questionnaire. GDS assessed the intensity of depression, participant felt in the preceding week (Greenberg, 2007). Children depression scales are significant components of assessing depression and their mental health. Children’s self-report measures of depression are relatively newer addition although fastest emerging in clinical psychology because of the importance of the issue. Weinberg Depression Scale for Children and Adolescents (WDSCA) is a 56 items, dichotomous response format measure developed for assessing depression in children and adolescent aged 5-21 years. Another commonly used questionnaire is Center for Epidemiological Studies Depression Scale Modified for Children (CES-DC) is a derivation of adult CES-D. CES-DC is a 20 items measure with the same statements although the wordings related to children’s level of comprehension (Faulstich, Carey Ruggiero, Enyart Gresham, 1986). One more measure for addressing depressive symptoms in terms of behavior and feelings in childrens is Childrens Depression Scale (CDS)-3rd Ed. CDS is a 50 item scale developed for the childrens 7 to 18 years of age. CDS has two depression and pleasure scales with separate forms for boys and girls (Poznannski, Cook Carroll, 1979). Multi-score Depression Inventory for Children (MDI-C) is developed for childrens age ranging between 8-12years. MDI-C is 79-items original scale and 47-items short version with true/false response format. MDI-C addressed children’s mood, affect, behavior, self-esteem, social interaction, defiance, and learned helplessness. Moreover there is another children inventory developed named Child Depression Inventory (CDI). CDI is an extension of BDI, with 27 items and 10 items scale for children and adolescents. The age is ranged between 7-17 years. CDI covers broad spectrum of child’s behavior, emotional problems in home and school living for preceding 2 weeks. Likewise, Mood and Feelings Questionnaire (MFQ) developed by Angold Costello (1987) assess the child’s recent feelings and affect. MFQ is a 33-items long form and 13-items short form, and score ranging between 0 (not true) to 2 (true) points. CHAPTER III METHODOLOGY Use of self administered diagnostic tool for depression has been increased these days as a quick and reliable step in measuring depression for accurate treatment regimen in patients with chronic illnesses. An analytical approach employed in the development of the Depression in Chronic Illnesses Scale (DCIS) i.e. the item selection and the method of assessing the individual’s level of Depression was based on a theory. In the case of present scale the theory was that of Beck’s (1967). The theory holds that cognitive distortions, dysfunctional beliefs and negative thoughts about an experience are responsible for having depression (Compass Gotlib, 2002). Mental and behavioral problems interlinked and begin because of the negatively twisted thinking processes. Furthermore, depression has four major components that are affective, cognitive, behavioral and biological. The present study carried out in two phases, where the first phase involved in development of the DCIS scale whilst second phase in validation of the newly developed scale. Phase I Development of the Depression in Chronic Illnesses Scale The development of scale involved following steps: Step 1: In-depth interview with chronically ill patients from various hospitals, view-points of health professionals and people from different community settings. Participants: Three different samples were taken for this step in which 30 participants (20 females and 10 males) of health professionals, 30 people (15 females and 15 males) from different community settings and 30 chronically ill patients (13 females and 17 males) from various hospitals of Karachi were recruited as respondents. Procedure: Health care professionals: 30 (20 females and 10 males) health care professionals (e.g. doctors, psychologists nurses) were approached. Their age ranged between 25-40 years. Initially a brief verbal presentation was given them about purpose of the study. Then they were requested to provide their view points for depression that could be their observation or experience in their lives (Annexure A, English) and (Annexure B, Urdu). Following instruction was given along with two sheets of paper. â€Å"Depression isa mental state described by one’s feeling of sadness, loneliness, hopelessness, low self-esteem, and self-reproach†. They were allowed to express their views easily in any language i-e English or Urdu. People from community settings: 30 participants (15 females and 15 males) from different community settings i.e house wives, office workers, teachers and students from colleges and universities of Karachi were approached. Their age ranged from 18-45 years. Initially the reason of the study was extensively explained to them. Then they were requested to provide their view points about depression that could be their observation or experience in their lives (Annexure A, English) and (Annexure B, Urdu). Following instruction was given along with two sheets of paper. â€Å"Depression isa mental state described by one’s feeling of sadness, loneliness, hopelessness, low self-esteem, and self-reproach†. They were allowed to express their views easily in any language i-e English or Urdu. Chronically ill patients: 30 chronically ill patients (13females and 17 males) were approached from different hospitals of Karachi. Their age ranged between 28-48 years. They were extensively and clearly explained the purpose of study and the reason for interview to put them in ease. They were further explained about confidentiality. A semi-structured in-depth interview was done on each chronically ill patient individually that explored their perspective, cognitions, feelings and behaviors about their illness in general and specific situations of life. They were asked open-ended questions (Annexure C), such as â€Å"how are you feeling today?† Their responses were recorded for further analysis. Results: The information explored during semi-structured in-depth interview with patients was summarized and analyzed. The point of views provided by health professionals and people from different community settings used for content analysis. The data from patients, heath care professionals and people from different community settings was qualitatively analyzed and common and relevant content was retained and uncommon content discarded. Step 2: item writing and selection Initially pool of the items were generated through quantitative analysis by using the definitions provided by the chronically ill patients, health professionals and people from different community settings (step 1) Few items from established measures of depression such as Beck depression inventory (1967) were selected and those selected items were culturally relevant items as well. Primarily the selected items were translated in Urdu then included in the item pool (step 2). Before given the item pool to the experts for rating, the content of the items was closely scrutinized by the researcher and supervisor to find out major weaknesses. Omissions and inclusions according to their relevance in each component were made and repetitive items and ambiguous items were deleted. Then, to determine the construct validity of the final scale the panels of judges/psychologists were asked to scrutinize items of the scale keeping in focus the Beck model of Depression. Psychologists were given printed material on the theoretical model of Depression as proposed by Beck (1967), that explained briefly and precisely the three aspects of depression, along with few sample items from already developed scale of Beck depression Inventory. After giving the material on Beck’s (1967) theory they were requested to rate each item on a 1 to 5 rating scale according to its relevance in each of the three components (Annexure D). They were asked to give an item a score of 1 if it is not at all related to the component/concept in question and give a rating of 4 or 5 if the item seems to be highly related to the component/concept in question. The items that had an average rating of 4 and above were selected and the items that had rating below 4 were discarded. Psychologists were replied back with their expert perspective in an objective manner to rate the formulated items for each component of the scale. Finally selected items were reduced to 28 total items (Annexure E). Step 3: Pilot Study Sample: A pilot study carried out by using the judge’s and psychologist’s rated scale and with the purpose of to evaluate the adequacy of scale and to make needed alterations accordingly. The sample of 60 (31 males 29 females) chronically ill patients and they were conveniently selected from various hospitals of Karachi. The age ranges of participants were between 18 to 50 years. Procedure: A 28 itemed scale was administered (Annexure F) on the participants with a demographic form in which they asked to write their name, age, education and illness. Those participants selected for pilot study who can comprehend Urdu easily. Further they were required to identify vague, repetitive, and difficult to understand items. Result: Finally selected scale after pilot study reduced to 18 items (Annexure G). Item those were difficult to understand, and vague for majority of the participants were excluded. Step 4: factor analysis and item total correlation Sample: To find out factor analysis and item total correlation, final Depression in Chronic Illnesses Scale (18 items) was administered on 270 (154 males, 116 females) chronically ill patients from various hospitals of Karachi. Their age ranged between 18- 50 years and they were conveniently selected. Procedure: Later than taking the written permission from hospital’s authorities, participants were explained about the details and purpose of the study along with a short demographic form, consent form (Annexure I) and final Depression in Chronic Illnesses Scale. Only those participants were included who volunteer to participate thus they could self-report the questionnaire. They were then requested to choose the one option of all eighteen items on DCIS, about which they think most related to their feelings during past six months. The choice of options was from strongly agree, agree and disagree to strongly disagree. Phase II: Validation of Chronic Illnesses Scale The second phase involved in determining the newly developed scale’s psychometric properties. Item total correlation, alpha internal consistency, split half reliability and convergent validity was calculated Reliability Analysis Sample and procedure: For test re-tests reliability a sample consisted of 60 chronically ill patients (26 females, 34 males), age ranging from 18-50 years, recruited from various hospital of Karachi and for internal consistency analysis sample consisted of 270 chronically ill patients (103 males, 90 females) with the age range of 18-50 years from different hospitals of Karachi. The Depression in Chronic Illnesses Scale was administered twice on participants at an interval of one week. Test re-tests reliability found out by computing Pearson r by using SPSS IBM version 22. Those participants comprehend easily the language of the scale were selected. For calculating internal consistency (item-total correlation inter-items correlation) Cronbach’s alpha was computed and for split half reliability all items were divided randomly into two equal sets, then split-half reliability estimated by the proportion between these two total scores. Validity Analysis To assess the convergent validity the two scales were administered along with DCIS on 100 chronically ill patients selected from various hospitals of Karachi, age ranging between 18 to 50 years. Only those participants were selected who were bilingual or easily comprehend English language. The two scales used for assessing convergent validity were, Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960) Procedure: Participants were asked to complete the Depression in Chronic Illnesses Scale with Center for Epidemiologic Studies Depression Scale. The Hamilton Rating Scale for Depression was used by the administrator. Measures: The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a 20-item self-report rating scale that assesses mood, somatic complaints, interactions with others, and motor functioning. It’s a 4-point rating scale, scores ranges from 0-3 (rarely or none of the time=0, some or little of the time=1, occasionally or a moderate amount of time=2 and most or all of the time=3). The final score spans from 0 to 60, with a higher score indicating high intensity of depression. People with a final score of 16 or lower are identified as non-depressed; however, the higher are typically identified as a depressive ‘case’ (Annexure I). Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960) is a 17-item, multiple choice clinician/health professional’s observation rating scale, design to assess the severity of depression in terms of mood, somatic complains, work and activity, sleep and insight. It’s a type of semi structured interview. Score ranging from 0-52, where score more than 23 indicative of very high intensity of depression, 19-22 high intensity, 14-18 moderate intensity, 8-13 mild and lower than 8 indicative of no depression (Annexure J). Cut off Scores In order to find out classificatory indices of DCIS, quartile 1, quartile 3 and intra-quartile had been calculated of eighteen items of the scale i.e. mild, moderate and severe level of depression in patients with chronic illnesses. Result: After computing the eighteen items of DCIS, the classificatory indices of the scores are, 0-16.25 indicates minimal depression, 17-25 indicates mild depression, 25-33 indicates moderate depression and more than 33 points indicates severe level of depression. Operational Definitions: Depression: Depression generally a state of mood characterize by a pessimistic sense of inadequacy dejection and a despondent lack of activity. Depression causes changes in view, emotion, behavior, and physical well-being. It is a widespread, intricate and complicated disorder, (Horwath, 2004). Reliability: Reliability of a test is referring to the consistency of a test.A test is reliable when it produces consistent and steady results over time (Phelan, Wren, 2005). There are different types of reliability in which, test re-test reliability is a correlation between the scores of same group test at two different times on same test. This type of reliability uses to evaluate consistency of a test over time. Inter-rater reliability achieved by given a test to more than one judges for rating. The ratings then compare to establish the consistency of a test. Internal consistency reliability is correlation between items of the same test. Split half reliability is correlation between two halves of one test to assess the internal consistency of a test. Parallel-forms reliability is measured by comparing the correlation of scores of two different tests used for assessing same construct. These two tests administered at same time on same sample Validity: Validity is one of the basic attributes of a test. Validity is a degree to which a test is measure what claims to measure (Cronbach, 1971). A test would be considered valid when it efficiently measures the specific characteristic that it means to be measure. There are four common types of estimation validity. Predictive validity is referring to the accuracy that how well a test guesses the future performance. The usual method is use to measure the approach to predict the future behavior solely on the basis of obtained scores. Criterion related validity used to predict future or current performance on a test. Content validity is referring to the extent to which how much a test represents every single item of the same construct. Construct validity refer to the extent to which a test measure a theoretical construct or attribute. Convergent and discriminant validity are two type of construct validity in which construct validity refers to which a test positively correlate with other measu re of same construct while discriminant validity refer to a test does not correlate with other measure of different construct (Campbell Fisk, 1959a).

Anatomy And Physiology Of The Affected System

The powerful heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical circulatory 24/7 blood supply. Without adequate and consistent blood, the heart becomes starved of oxygen and vital nutrients it requires to work properly and efficiently.   Coronary artery disease or Atherosclerosis occurs when the arteries become clogged and narrowed, restricting blood flow to the heart. (Heart Attack, 2006)   â€Å"The main myocardial infarction causal effects under investigation include blood pressure, hypertension, the use of antihypertensive and/or cardiovascular medication and angina pectoris.† (Caroline B. Ameling et al. 2002, p. 307)Pathology Of The DiseaseThe arteries leading to the heart become narrow and blood cannot flow consistently and evenly. Fatty matter, calcium, proteins and inflammatory cells build up within the arteries to form plaques of different sizes and irregular shapes. The plaque dep osits are hard on the outside and soft and mushy on the inside.When the plaque's deposits harden, the outer shell cracks (plaque rupture) and platelets (disc-shaped particles in the blood that aid clotting) arrive at the heart area, and blood clots form around the plaque. When the blood clot completely blocks or inhibits the artery, the heart muscle and tissue is rapidly depleted of oxygen. Within a short time, damage of the heart muscle cells occurs, causing permanent impairment. The end result, in medical terms is a myocardial infarction (MI), or heart attack.   â€Å"While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia).† (Heart Attack, 2006)Current Treatment OptionsImmediate treatment options include supplemental oxygen therapy, however it is the only form of treatment that improves survival in hypoxemic patien ts, no clear relationship exists between improved survival and reduction in pulmonary vascular resistance with oxygen therapy. (Susan Wilansky et al. 2002, p. 629)   Individuals with angina or chronic chest pains can take nitroglycerin pills to cause the pain to disappear. Because angina patients often have chest pains, the key heart attack symptoms may be lightheadedness, sweating, nausea, or shortness of breath, in addition to chest pain. (Christopher Wanjek, 2003, p. 242)For long term treatment at a hospital, individuals are taken to the cardiac catheterization lab where a doctor will evaluate the coronary arteries to determine whether angioplasty or coronary artery bypass graft surgery is appropriate.Patient EducationThe traditional approach to patient education interventions requires a health educator to meet with patients individually or to provide lectures. Some educational approaches appear to be cost-effective has shown that education programs emphasizing self-management of one's health and prevention strategies are effective in increasing patients' self-efficacy and health status. â€Å"Therefore it appears important to measure any changes in self-efficacy and helplessness that may result from either education and/or social support interventions. Such measures make it possible to evaluate the sense of control over health decisions and outcomes that has been associated with health status and health care costs.† (Terry A. Cronan et al. 2000, p. 455)Community referral sourcesAmerican College of Cardiology, 9111 Old Georgetown Road Bethesda, MD   20814-699 Phone:   1-800-253-4636, extension 694WomenHeart: The National Coalition for Women With Heart Disease 818 18th Street, N.W. Suite 230 Washington, DC   20006 Phone:   (202) 728-7199American Heart Association (AHA)   7272 Greenville Avenue Dallas, TX   75231 Phone:   1-800-AHA-USA1 (1-800-242-8721) Web Address:   http://www.americanheart.orgPreventionTension and anxiety were foun d to be good predictors of disease and mortality even when other risk factors were controlled. More recently, it has been prospectively shown that earlier measures of anxiety were significantly related to the development of atherosclerosis disease. (Stanley Chin et al. 2004, p. 63)Preventive life choice behavior modification includes stop smoking, controlling cholesterol through a healthy diet, managing blood pressure with exercise, relaxing and reducing stress by managing depression and anger.Reference(s)Caroline B. Ameling, Hendriek C. Boshuizen, Augustinus E.M. De Hollander, Hanneke Kruize, Brigit A.M. Staatsen, Elise E.M.M. Van Kempen, 2002, The Association between Noise Exposure and Blood Pressure and Ischemic Heart Disease: A Meta-Analysis. Journal Title: Environmental Health Perspectives. Volume: 110. Issue: 3. Publication Year:. Page Number: 307+. COPYRIGHT 2002 National Institute of Environmental Health Sciences;http://www.webmd.com/hw/heart_disease/tx2300-ConRes.asp   He art Attack and Unstable Angina Retrieved December 28, 2006Jiang He, Gail T. Louis, Paul K. Whelton, 2003, Lifestyle Modification for the Prevention and Treatment of Hypertension. Publisher: Marcel Dekker. Place of Publication: New York. Page Number: 278.Susan Wilansky, James T. Willerson, 2002, Heart Disease in Women. Publisher: Churchill Livingstone. Place of Publication: New York. Page Number: 629.Christopher Wanjek, 2003, Bad Medicine: Misconceptions and Misuses Revealed, from Distance Healing to Vitamin O. Publisher: Wiley. Place of Publication: New York. Page Number: 242.Terry A. Cronan, Erik J. Groessl, 2000, A Cost Analysis of Self-Management Programs for People with Chronic Illness Journal Title: American Journal of Community Psychology. Volume: 28. Issue: 4. Page Number: 455. COPYRIGHT 2000 Plenum Publishing Corporation;

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Intercultural Business †Drug Tests in India Free Essays

string(98) " could be more difficult to find an easy solution but it might be more suitable for both parties\." Case Study Intercultural Business im Studiengang B. A. International Management Thema: Drug tests in India IContents IContentsII IIList of figuresIII IIIList of abbreviationsIV 1Essential moral standards and norms1 2The practical value of economic ethics concepts3 3The RADAR concept5 4Business activity in India8 5Comparison of the cultures9 6Preperation for the NGO meeting14 IV. We will write a custom essay sample on Intercultural Business – Drug Tests in India or any similar topic only for you Order Now BibliographyV Declaration IIList of figures Figure 1:Overview of the different business ethics concepts3 Figure 2:Points of the RADAR concept5 Figure 3:Comparison of the differen cultural dimensions9 ? IVList of abbreviations BVVB AGBacteria and Virus Vaccine Biotechnology CRE Ltd. Clinical Researche Enterprise Limited NGONon-Governmental Organisation WMAWorld Medical Association PDIPower Distance IDVIndividualism vs. Collectivism MASMasculinity vs. Femininity UAIUncertainty Avoidance LTOLong-Term Orientation CfConfer ? 1Essential moral standards and norms â€Å"Humans are more moral than they think and far more immoral than they can imag-ine. † Sigmund Freud In general moral standards and norms are always based on a culture. Every culture has got its own definition of morality and ethics. Morality can be defined as the standards that an individual or group has got about what is right and wrong, or good and evil. The pharma industry itself includes some essential moral standards and norms on na-tional and international base. First it is necessary to prove moral standards and norms on a global level. The â€Å"Declara-tion of Helsinki† developed by the World Medical Association (WMA) is: â€Å"a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data. Furthermore this declaration gives essential moral standards and norms according to the pharmaceutical branch, e. g. â€Å"In medical research involving human subjects, the well-being of the individual research subject must take precedence over all other interests. † The second part is the national moral standards. In Germany the ethical standards refer to the principle: â€Å"The health is the highest property of a human bein g. † These standards are set by statue from the â€Å"Zentrale Ethikkommission†. Furthermore German companies always have to obey the German law. The American ethical standards are saying the same in the â€Å"Declaration of Professional Responsibility: Medicine’s Social Contract with Humanity. † from the American Medical Association, e. g. â€Å"Respect human life and the dignity of every individual† The focused standards above exist also in India. They are formed by the Indian Council of medical research. All standards point out what the ultimate principle of medical researches is. : All medical tests shall focus on health and care of every human being. â€Å"Act as if the maxim of your action were to become through your will a universal law of nature. Immanuel Kant by Serafini (1989) The definition of moral standards and norms above should be based on deontological ethics. It says that the background and the consequences or effects that an action takes is irrelevant – only the action itself matters. Roughly speaking, deontologists hold that some choices cannot be justified by their effects, no m atter how morally good their con-sequences are. Therefore some choices are morally forbidden. But in reference to the drug tests the moral standards are based on the teleological theo-ry. The teleology is characterized primarily by a focus on the consequences which any action might have. That means if an action (drug tests) might be incorrect, but the con-sequence (effective medicine) is correct and helpful, then it is morally correct. Today we are encouraged to act on the base of different ethical frameworks before we are able to make a clear decision about the ethical correctness of our intended actions. The codes of conduct, which are the ethical guidelines are based on those frameworks. 2The practical value of economic ethics concepts The following discussion deals with the four different economic ethics concepts and their practical values. They are defining how to combine ethics and profit in different ways and with their consequences. Figure 1 The different business ethics concepts Firstly there is the functional business ethics concept. If a company act in agreement with certain known rules and under specific ethical conditions it is allowed to gain the maximum profit. â€Å"Ethic† is a â€Å"factor or rentability† or a â€Å"critical factor of success†. That means: The â€Å"investment† in â€Å"ethics† in terms of acceptance of current opportunity costs has its foundation in the strategic aim to save long-term profit chances. This concept is not used by the BVVB AG, because they are not acting under specific ethical conditions. The second concept to focus is the corrective Business ethics concept which implements ethical standards into the daily business. That means companies are acting in their nor-mal economic way but ethics standards always have the priority over profit gaining ac-tions. It is a voluntarily self-limitation of profit maximisation. For the BVVB AG only the profit gaining process matters. The integrative Business ethic is the permanent process of critical reflexion of business activities. Every possible profit and business success should get the legitimisation of all stakeholders. The consequence is that the company might have to abdicate a profit chance. The action of the BVVB AG shows that they are not acting in reference to what the stakeholders defining as the best way. The last concept is the charitable Business ethic concept. The priority is to gain the maximum profit and afterwards the company starts to donate a part of the money for charitable aims. The morality of a business action does not matter anyway. Due to the descriptions of the different concepts it is clear that the BVVB AG should act based on the charitable business ethics concept. In the current situation it is the highest priority to gain profit and to be successful (=gain the maximum profit). But after having success the BVVB AG should use a part of the gained money to serve non-economical claims. The practical value of the concept is the possibility to define an eth-ical business aim and the commitment to act in a moral and ethical way. 3RADAR concept The RADAR concept serves to take a decision with the comprehension of ethics. In consideration of ethics in the factoring process it could be more difficult to find an easy solution but it might be more suitable for both parties. You read "Intercultural Business – Drug Tests in India" in category "Papers" In the following paragraph the steps 1 to 10 of the RADAR concept, as seen in the fol-lowing image, will be analysed and discussed. Figure 2: Structure and Points of the RADAR concept Recognize Step 1 Determine if there is an ethical component The component is the drug tests in India. The accomplishment of these tests is not un-morally – it is important – but the way the tests will be carried out is morally questiona-ble. The BVVB AG could hold the tests in Europe or the USA but due to finical prob-lems and the necessity of the reduction of costs the tests will be done in a financially weak area in an Indian hospital. Furthermore the BVVB AG does not know if the health of the patient will be always protected. Step 2Check the ethicalness of the ethical omponent against ethical standards For my own values the conditions under which the tests are carried out are not morally and direct against my ethical values. For the BVVB AG it depends on two points. On the one hand India is the cheapest choice for the realization of the test process and on the other hand the company is not acting illegal but the aim is to develop a new effective medicine against illn esses and to test the agent, subjects are needed. On the basis of the Global Business Standard Codex (GBSC) it is absolutely unmorally. The codex considers the point â€Å"Human Dignity†, which requires the protection of hu-man health and the respect of fundamental human rights. Step 3Conclusion In consideration of the mentioned aspects above the implementation of the tests in India is not illegal but they fulfil not the ethical and moral standards. Assess Step 4Who are the key stakeholders? The main stakeholders of the BVVB AG and the new vaccine are primary the internal stakeholders, especially the managers and employees. Because of the financial situation the members of the BVVB AG are reliant on the success of the tests. The external stakeholders are the subjects, without their help the tests cannot be carried out. Step5What ethical standards apply? The CRE Ltd. and the BVVB AG carry responsibility to inform the respondent about the possible side effects and the probability of their appearance. Furthermore the com-pany is responsible to take care about the state of the subjects’ health. In turn of these duties the subjects have the right to be treated with fairness and dignity. Step 6 How is the proposed action likely to impact them from an e. g. economic and ethical view? The positive long- and short-term effects are that the habitants from India, especially the majority of people from slums, have never had contact to medical treatments or a simple medical examination. For the people who are part of the tests it could lead to the healing of diseases. Contrariwise there also exist some negative effects in a short-term period – the side ef-fects. The subjects could get negative side effects from the vaccine. But the laboratory has figured out medical therapies to heal the serious side effects either by a special treatment or through hospital stay. Step 7See if there is a specification and quantification of the positive and negative con-sequences which could result from the intended action. The performing of the tests in India could result in bad or negative reputation. Too much bad reputation could result in a damage of the company’s image and could end up in the loss of clients and creditors. This would indicate that the BVVB AG takes a financial risk. Step 8What could be done to reduce the likelihood of or at least reduce the negative impact? Due to the necessity of the tests the company has to ensure the reduction of negative reports. To avoid them the only way is to guarantee better circumstances of the tests and the security and wellbeing of the subjects. Furthermore the company could assure that India receives some medicine for free to help infected people after a successful conclu-sion of the test series. Decide Step 9 Take a decision The BVVB AG in connection to the CRE Ltd. has to carry out the tests in India, be-cause of the financial situation. To some people it may create the impression of being â€Å"bad† but the real aim something positive one. The vaccine could help millions of people and also Indians. To reduce the negative aspects the tests have to be carried out under better conditions, considering a higher care for the subjects’ health. Step 10 Correct for self-serving biases If I am asked if I want to read about that in the newspaper I would say â€Å"Yes† because reaching better conditions and to ensure the responsible manners with the tests and the well-being of the persons is positive and could have an effect on the image and make other companies to think about their actions. ? 4Business activity in India This paragraph defines some essential facts about cultural conventions in India. To have success on business in India, in my opinion, the first priority is to be familiar with the cultural conventions because the opinion about business differs a lot between Indians and Europeans. The distinctions may lead to misapprehensions. To be accepted and to show respect it is necessary to learn some basic modes of behaviour and funda-mental cultural differences. It could be helpful to learn some basic phrases of the Indian language for having a small-talk but it is not that important to speak perfectly because the Indians speak over 500 dialects e. . people from the north often talks to someone from the south in English. Furthermore it is good to know that Indians never say â€Å"No† because it is impolite to negate something. It is common to say â€Å"I will try it†. Generally it is important to keep in mind that a personal and polite contact between people from every age is ensured. Indians set a high value on trustworthiness. The first contact could be a h andshake but it is common to give a friendly nod. Shaking the head does not mean â€Å"No† it is a gesture of attentive listening. Also the way of dressing is important. Women may never show skin, like naked legs or shoulders. Men are allowed to wear shorter clothes if it is hot outside but it has to be suitable for business. Indians are very hospitable. It is common to get or to make an invitation for dinner. Due to the different persuasion there are some different rule for preparation and consump-tion. But it exists a general rule: â€Å"Peel it, boil it, or forget it. † ? 5Comparison of the cultures The following paragraph deals with the different cultures of Germany, India and USA. The distinctions between the different nations and cultures will be discussed and ex-plained with the help and use of the cultural dimensions of Geert Hofstede. Professor Geert Hofstede conducted one of the most comprehensive studies of how values in the workplace are influenced by culture. Figure 3: The different cultural dimensions in comparison of their characteristics source: geert-hofstede. com The 1st dimension – The Power Distance (PDI) Power distance is defined as: â€Å"The degree to which the less powerful members of a so-ciety accept and expect that power is distributed unequally. The undamental issue here is how a society handles inequalities among people. People in societies exhibiting a large degree of power distance accept a hierarchical order in which everybody has a place and which needs no further justification. In societies with low power distance, people strive to equalize the distribution of power and demand justification for inequalities of power. † The comparison of the cultures in the diagram shows that there is a high difference be-tween the USA, Germany and India. The low score of Germany (35) and the USA (40) in this dimension shows clearly the general proposition of â€Å"liberty and justice for all†. It is common that both managers and employees expect to be engaged and information is shared frequently. Also both cul-tures have in common that the communication style is direct, informal and participative. Furthermore in both cultures there is no strict hierarchical order established. But in India on the contrary there is a relatively high power distance (77). The hierarchical structure is hard in organizations as well as in society. Also the real power of managers and control is high and accepted. The communication style differs totally from the western and European style. Someone would never be criticized if there is a 3rd person in the room and the communication is top – down. In contrast to Germany and the USA, where also an employee may criticize a manager, in India an employee would never give negative feedback to someone who is up the ladder 2nd dimension – Individualism versus Collectivism (IDV) Individualism, the high side of this dimension, can be defined as: â€Å"A preference for a loosely-knit social framework in which individuals are expected to take care of them-selves and their immediate families only. And collectivism, the low side of this dimension, can be defined as: â€Å"A representation of a preference for a tightly-knit framework in society in which individuals can expect their relatives or members of a particular in-group to look after them in exchange for unquestioning loyalty. † A society’s position on this dimension is reflected in whether people’s self-image is de-fined in terms of â€Å"I † or â€Å"we. † As seen in the 5-D-Modell, all three countries and their cultures have different levels of this dimension. The USA, with a score of 91 is highly individualistic. That means it is common that people in general first look and take care for themselves and their families. The Ameri-cans are mostly doing business with strangers and employees are expected to be self-consistent. Germany scored 67 – truly individualistic. In comparison to the USA the bigger family means a lot to the Germans, especially the parent-children relationship. Loyalty, duty and responsibility are common. In business it is common to give someone an advice if there was a mistake to give him the chance to learn from it – â€Å"Be honest, even if it hurts†. In contrast to Germany and the USA India is clear collectivistic with a score of 48. To Indians it means a lot what the social framework is thinking about an action and they are asking for advice. Also in business everything starts with a personal relationship, especially hiring and promotion. 3rd dimension – Masculinity versus femininity (MAS) This dimension is defined as: â€Å"The masculinity side of this dimension represents a pref-erence in society for achievement, heroism, assertiveness and material reward for suc-cess. Society at large is more competitive. Its opposite, femininity, stands for a prefer-ence for cooperation, modesty, caring for the weak and quality of life. Society at large is more consensus-oriented. â€Å" The fundamental issue here is what motivates people, wanting to be the best (masculine) or liking what you do (feminine). All three cultures are considered a â€Å"masculine† society (scores 56 – 66). Children learn from the early times on that performance is highly valued and the people â€Å"live in order to work†. It is also relevant to be authorial, assertive and decisive. Their behavior stands under the conditions â€Å"strive to be the best they can be. and worldwide known sentence: â€Å"the winner takes it all! † All cultures love to show their success through material objects. For Indians â€Å"work is the center of life† and the workplace serves as symbol of success. 4th dimension – The Uncertainty avoidance (UAI) The uncertainty avoidance dimension expresses: â⠂¬Å"The degree to which the members of a society feel uncomfortable with uncertainty and ambiguity. The fundamental issue here is how a society deals with the fact that the future can never be known: should we try to control the future or just let it happen? Countries exhibiting strong UAI maintain rigid codes of belief and behavior and are intolerant of unorthodox behavior and ideas. Weak UAI societies maintain a more relaxed attitude in which practice counts more than prin-ciples. † Concerning the Uncertainty avoidance the cultures have differences. Americans accept new ideas and innovations. They are more tolerant of ideas or opinions from anyone and allow the freedom of expression. Indians also have a lower preference for avoiding un-certainty. They have a high acceptance of imperfection and do not follow strict rules. Indians say: â€Å"nothing is impossible†, as long as one knows how to â€Å"adjust†. In comparison Germany scored high (65) and they follow deductive methods. For Germans it is important to have a plan. Every action has to be systematically and de-tailed planned. Germans prefer to compensate for their higher uncertainty by strongly relying on expertise. 5th dimension – Long-term orientation (LTO) â€Å"The long-term orientation dimension can be interpreted as dealing with society’s search for virtue. Societies with a short-term orientation generally have a strong concern with establishing the absolute Truth. They are normative in their thinking. They exhibit great respect for traditions, a relatively small propensity to save for the future, and a focus on achieving quick results. In societies with a long-term orientation, people believe that truth depends very much on situation, context and time. They show an ability to adapt traditions to changed conditions, a strong propensity to save and invest thriftiness, and perseverance in achieving results. † America and Germany have a relatively low score in this dimension. That means they are more short-term oriented. In business people strive for quick results and a strong concern with establishing the truth. The Indians in contras have a long-term orientation, time and punctuality does not matter and they never follow the exact plan, if there is a plan existing. ? 6Preperation for the NGO meeting â€Å"Morality is temporary, wisdom is permanent. † Hunter S. Thompson For the meeting with the NGO? s in India it is necessary to know what they are criticiz-ing on the project. They are criticising that the BVVB AG is exploiting the Indian popu-lation due to the tests in India. The need of that meeting is to convince the members of the NGO about the necessity and benevolence of these tests. It is obvious that the BVVB AG in cooperation with the CRE Ltd. is doing the tests in India in order to eco-nomic and financial reasons. But due to the extensive economies it could also be beneficial for India, especially if the BVVB AG decides to act on the charitable business concept. The non-attendance of tick-bourne in India does not matter for testing the medicine. The danger to contract an infection is small and there is also existing medicine and plans how to heal the people in case of an infection. Furthermore it is of a high importance to know everything about the negative media reports. To convince the NGO about the tests it would be helpful to adjust with the BVVB AG management if it could be possible to donate a certain contingent of the profit and also to donate a certain percentage of the vaccine to India to combat the leprosy virus. Furthermore it could be helpful to assure that the CRE Ltd. will care for good circum-stances. The subjects will get a good treatment and the welfare will be ensured. Due to the fact that Panjaa is a Non-Governmental-Organization it would be not effec-tive trying to bribe the organization with money. It would be more effectively to show them the good sides of the tests for the Indian nation. ? 1. Bibliography Literature FREUD, Sigmund (1930), â€Å"Civilisations and its Discontents† KANT, Immanuel, â€Å"Good Will, Duty, and the Categorical Imperative,† ed. Anthony Serafini, Ethics and Social Concern (1989) (New York: Paragon House Publishers) LIPPER RASMUSSEN, Kaspar (2005) „Deontology, Responsibility and Equalityâ€Å" SALZMANN, Todd A. 1995), „Deontology and Teleologyâ€Å" ULRICH, Peter (2008), „Integrative Business Ethics: Foundation of a Civilized Market Econo-my† ULRICH, Peter (1997), â€Å"Integrative Wirtschaftsethik – Grundlagen einer lebensdienlichen Okonomie† Web research Homepage from the World Medical Association: â€Å"The Declaration of Helsinki†. URL: www. wma. net/en/30 publications/10policies/b3/ (last downloaded 09. 11. 12) Homepage from the Freiwillige Selbstkontrolle fur die Arzneimittelindustrie e. V. , „Verhal-tenskodexâ€Å", URL: http://www. fs-arzneimittelindustrie. e/verhaltenskodex/ivd/ (last downloaded 14/11/2012) Statement from the Arbeitskreis Medizinischer Ethik-Kommission, „Stellungnahme zum Vor-schlag fur eine Verordnung des Europaischen Parlaments und des Rates uber klinische Pru-fungen mit Humanarzneimitteln und zur Aufhebung der Richtlinie 2001/20/EGâ€Å" URL: http://www. ak-med-ethik-komm. de/documents/StellungnahmeEUVerordnungklinischePruefungen. pdf (last down-loaded14/11/2012) Hompage from the American Medical Association, „Declaration of Professional Responsibil-ity†, URL: http://www. ama-assn. rg/ama/pub/physician-resources/medical-ethics/declaration-professional-responsibility. page? (last downloaded 14/11/2012) Homepage from the Zentrale Ethikkommission bei der Bundesarztekammer, „Priorit aten in der medizinischen Versorgung im System der Gesetzlichen Krankenversicherung (GKV): Mussen und konnen wir uns entscheiden? â€Å" (2000), URL: http://www. zentrale-ethikkommission. de/page. asp? his=0. 1. 24 (last downloaded 14/11/2012) Published paper by the Indian Council of Medical Research, â€Å"Ethical Guidelines for biomedi-cal research on human participants†, (2006), URL: http://icmr. ic. in/ethical_guidelines. pdf (last downloaded 14/11/2012) Homepage from Handelsblatt, FRANK, Sergey „Die indische Kultur besser verstehenâ€Å", (2009) URL: www. handelsblatt. com/unternehmen/management/strategie/weltspitze-die-indische-kultur-besser-verstehen/3304528. html (last downloaded 10. 11. 2012) Homepage from Geert Hofstede, URL: geert-hofstede. com (last downloaded 12/11/2012) http://www. goodreads. com/quotes/178430-morality-is-temporary-wisdom-is-permanent (last downloaded 12/11/2012) How to cite Intercultural Business – Drug Tests in India, Papers

Construction, Design and Analysis of a Single

Construction, Design and Analysis of a Single-lesi Essay on Containing Shuttle Vector for Use in Studies of Transcription-coupled DNA Repair This summer, I have had the incredible opportunity of working with ___ under the direct mentorship of ___ on designing, constructing and analyzing a single-lesion containing shuttle vector to be used for studies of transcription-coupled DNA repair (TCR). This experience has provided me with insight into the logic behind genetic engineering and experiment design and given me greater aptitude in various laboratory procedures including RT-PCR (reverse transcriptase polymerase chain reaction), plasmid transfection and recovery, plasmid transformation and amplification, and RNA isolation. It was the creativity of the design-associated aspects of our project that I found most satiating. In fact, in order to keep up with the evolution of the construction design, I learneda good deal of interesting biology that I now find the most valuable aspect of my internship. Enthusiastic about the knowledge I have gained while spending my days at the Cooper lab, I feel compelled to write this web-page with a focus that emphasizes the progression of my understanding about TCR and single-lesion containing shuttle vectors while it describes the experiments and protocol optimizations I performed. AbstractOur goal is to design a shuttle vector that contains a unique, site-specific lesion in order to study transcription-coupled repair of human DNA. In our system, the lesion is introduced by insertion of a synthesized 8-oxoguanine-containing oligomer into a pS189-derived plasmid at either of two locations: within the t-antigen (Tag) intron 400 bases beyond the ATG translation start codon, or at the end of the Tag, after the polyadenylation signal. The pS189 shuttle vector was modified to increase the transcription frequency of the Tag, prevent plasmid replication, and distinguish between Tag derived from SV40-transformed cells and that from the shuttle vector. Initial studies were undertaken to optimize the transfection conditions and also to verify the various plasmid alterations. Preliminary RT-PCR of mRNA harvested 24 hours after plasmid transfection has demonstrated that use of primers tuned to the Tag modifications do successfully distinguish plasmid from cellular RNA. Replication assays using methylation-sensitive endonucleases have verified the competence of engineered mutations in the SV40 ori in achieving preclusion of plasmid replication. RT-PCR has also shown low amplification near the Bgl II site, suggesting its removal during the processing of mature mRNA. It will therefore be necessary to construct a new site for lesion insertion before the poly-adenylation signal. In conclusion, with the competency of the pS189-derived plasmids confirmed by RT-PCR, both the shuttle vector and the transfection protocol have been optimized for TCR studies, and we are ready to insert the 8-oxoG-containing oligomer. IntroductionToward maintenance of genomic integrity and to combat the mutations and genetic degradation associated with aging and cancer, several intricate and interconnected pathways exist for DNA repair. These repair pathways include nucleotide excision repair (NER) and base excision repair (BER). Excision and repair of lesions on the transcribed strand (TS) occurs at a higher frequency than on the non-transcribed strand (NTS). This phenomenon called transcription-coupled repair (TCR) seems to be initiated by RNA polymerase II stalled at lesions or lesion-protein complexes. Lesions introduced by reactive oxygen species generated during cellular metabolism, including 8-oxoguanine (8-oxoG), are subject to TCR, even though they do not impede DNA polymerase during replication. If left unrepaired, 8-oxoG lesions can mispair with adenine and, upon replication, cause a guanine to thymine transversion with 50% frequency. Impedance of TCR results in a degenerative disease, Cockayne Syndrome (CS), characterized by postnatal developmental failure, neurological degeneration and early death. Another disease, Xeroderma Pigmentosum (XP), involves the global malfunction of nucleotide-excision repair (NER) due to mutations in the XPA-XPG proteins. Previously, investigators introduced oxidative lesions in a random, stochastic manner, making the detailed kinetics of TCR difficult to assay. .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .postImageUrl , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .centered-text-area { min-height: 80px; position: relative; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:hover , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:visited , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:active { border:0!important; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .clearfix:after { content: ""; display: table; clear: both; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:active , .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .centered-text-area { width: 100%; position: relative ; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:hover .ctaButton { background-color: #34495E!important; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5 .u4ec2d6ecb734c6d9b46b4d2362d6dfd5-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u4ec2d6ecb734c6d9b46b4d2362d6dfd5:after { content: ""; display: block; clear: both; } READ: Frees: Black Success through Hard Work or Af Essay These limitations can be surpassed with the constructing of site-specific single-lesion containing shuttle vectors. Our Research GoalsTo study transcription-coupled repair of oxidative damage to DNA in various cell lines from Cockayne Syndrome (CS) and Xeroderma Pigmentosum (XP) patients, using a single-lesion containing shuttle vector. To further characterize both the requirements for XPD/XPB/XPG in TCR, and the behavior of RNA Polymerase near oxidative lesions. To further assess the degree to which lesions caused by oxidative damage (specifically